title: Spatial variations in the incidence of breast cancer and potential risks associated with soil dioxin contamination in Midland, Saginaw, and Bay Counties, Michigan, USA.
abstract: BACKGROUND
  High levels of dioxins in soil and higher-than-average body burdens of dioxins in local residents have been found in the city of Midland and the Tittabawassee River floodplain in Michigan. The objective of this study is threefold: (1) to evaluate dioxin levels in soils; (2) to evaluate the spatial variations in breast cancer incidence in Midland, Saginaw, and Bay Counties in Michigan; (3) to evaluate whether breast cancer rates are spatially associated with the dioxin contamination areas.
  
  
  METHODS
  We acquired 532 published soil dioxin data samples collected from 1995 to 2003 and data pertaining to female breast cancer cases (n = 4,604) at ZIP code level in Midland, Saginaw, and Bay Counties for years 1985 through 2002. Descriptive statistics and self-organizing map algorithm were used to evaluate dioxin levels in soils. Geographic information systems techniques, the Kulldorff's spatial and space-time scan statistics, and genetic algorithms were used to explore the variation in the incidence of breast cancer in space and space-time. Odds ratio and their corresponding 95% confidence intervals, with adjustment for age, were used to investigate a spatial association between breast cancer incidence and soil dioxin contamination.
  
  
  RESULTS
  High levels of dioxin in soils were observed in the city of Midland and the Tittabawassee River 100-year floodplain. After adjusting for age, we observed high breast cancer incidence rates and detected the presence of spatial clusters in the city of Midland, the confluence area of the Tittabawassee, and Saginaw Rivers. After accounting for spatiotemporal variations, we observed a spatial cluster of breast cancer incidence in Midland between 1985 and 1993. The odds ratio further suggests a statistically significant (alpha = 0.05) increased breast cancer rate as women get older, and a higher disease burden in Midland and the surrounding areas in close proximity to the dioxin contaminated areas.
  
  
  CONCLUSIONS
  These findings suggest that increased breast cancer incidences are spatially associated with soil dioxin contamination. Aging is a substantial factor in the development of breast cancer. Findings can be used for heightened surveillance and education, as well as formulating new study hypotheses for further research.
authors.affiliation: Environmental Resources and Policy Program, Southern Illinois University, 405 West Grand Avenue, MC 4637, Carbondale, IL 62901-4637, USA. ddai@niu.edu
authors.forename: Dajun
authors.initials: D
authors.lastname: Dai
authors.forename: Tonny J
authors.initials: TJ
authors.lastname: Oyana
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000368:Aged; D001943:Breast Neoplasms / Q000139:chemically induced* / Q000453:epidemiology* / Q000473:pathology; D016208:Databases, Factual; D004147:Dioxins / Q000032:analysis / Q000633:toxicity*; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005260:Female; D005843:Geography; D019015:Geologic Sediments / Q000032:analysis*; D006801:Humans; D015994:Incidence; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009010:Monte Carlo Method; D011336:Probability; D012042:Registries; D018570:Risk Assessment; D045483:Rivers; D012989:Soil Pollutants / Q000032:analysis / Q000633:toxicity*; D015996:Survival Rate
chemical_list: D004147:Dioxins; D012989:Soil Pollutants